<!DOCTYPE html>
<html lang="en">
	<head>
		<meta charset="utf-8" />
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		<meta http-equiv="X-UA-Compatible" content="IE=edge,chrome=1" />
		<title>index</title>
		<meta name="description" content="" />
		<meta name="author" content="Base Datos" />
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        <style type="text/css">
body{
	margin-top:1px;
	font-family:Arial, Helvetica, sans-serif;
	color:#51555C;
	height:100%;
	background:url(../img/5a.jpg);
	font-size:16px;
}
#div-regForm,.registered{	
	border:1px solid #eeeeee;
	padding:15px;
	color:#C36;
	
	margin:30px auto 40px 25px;
	width:450px;
}


</style>
	</head>
	<body>
    <div id="div-regForm">
    <div class="form-title" align="center" ><h1>Registro Pagos</h1></div>
<form name="formulario" action="../procesa/procesa_pagos.php" method="post">
			<table width="1008" border="0">
            <tr>
            		<td width="212" height="32">Número de Registro:</td>
                    <td width="786">
            		<input name="fcod" type="text" size="28" / >
                    </td>
          		</tr>
                <tr>
            		<td width="212" height="32">Monto del Pago:</td>
                    <td width="786">
            		<input name="fmon" type="text" size="28" / >
                    </td>
          		</tr>
                <tr>
					<td height="40">Fecha del Pago:</td>
					<td>
			            <select name="day">
	             		<option value="0">Dia:</option>
                        <?php 
						for($i=1;$i<=31;$i++)
						echo "<option>".$i."</option>";						
						?>
    	                </select>
             
		 	            <select name="month">
	            		<option value="0">Mes</option>
                        <?php 
						for($i=1;$i<=12;$i++)
						echo "<option>".$i."</option>";						
						?>
    			        </select>
                        
	        		    <select name="year">
		    	        <option value="0">Año:</option>
                        <?php 
						for($i=2012;$i<=2030;$i++)
						echo "<option>".$i."</option>";						
						?>        
        			    </select>
					</td>
				</tr>
                <tr>
            		<td width="212" height="32">Numero de Recibo:</td>
                    <td width="786">
            		<input name="fnumrec" type="text" size="28" / >
                    </td>
          		</tr>
				<tr>
					<td height="45"><input type="submit" value="ENVIAR"/></td>
				  <td><input  type="reset"  value="LIMPIAR"/></td>
				</tr>
			</table>
            
		</div>
		</div>
</form>
		<div id="error">
			<?php
 		echo " ";
		?>
		</div>
		
	</body>
</html>